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Decreasing Falls with the Automation of
Beers Criteria Medications
Session #312, February 15, 2019
Siraj Anwar, Associate Chief Medical Informatics Officer
Memorial Hermann Health System
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Siraj Anwar, MBBS, MS, CPHIMS
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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Background: Elderly and Medication Use
Introduction to Beers Criteria/ List
Governance Model
HIT Interventions
Measuring Success
Closing Thoughts
Agenda
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Discuss how Clinical Decision Support can
improve safety, quality and cost-effectiveness of
patient care
• Explain how the EHR’s ability to add filters for
age and conditions, as well as dose range
checking alerts, improves the automation and
reliability of the CDS alerts
Describe the importance of governance when
using CDS
Learning Objectives
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292 Care Delivery Sites
Our Network of Care
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Awards & Recognition
2005-2012
Top 5!
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Background
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What percent of the U.S. population is over
65 years of age?
~15.6%*
~51 Million
Background
* United States Census Bureau
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Background
Hospitalizations, by age: United States, 2000-2010
SOURCE: CDC/NCHS, National Hospital Discharge Survey, 20002010
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Adverse Drug Events
~770,000 people are injured or die annually
1-3
Spend 8-12 days longer in hospital
Costs $16,000-$24,000 +
9.7% of ADEs result in permanent disability
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References
1. Classen DC, Pestotnik SL, Evans RS, et al. Adverse drug events in hospitalized patients. JAMA
1997;277(4):301-6.
2. Cullen DJ, Sweitzer BJ, Bates DW, et al. Preventable adverse drug events in hospitalized patients: A
comparative study of intensive care and general care units. Crit Care Med 1997;25(8):1289-97.
3. Cullen DJ, Bates DW, Small SD, et al. The incident reporting system does not detect adverse drug events: A
problem for quality improvement. Journal on Quality Improvement 1995;21(10):541-8.
4. Thomas EJ, Studdert DM, Burstin HR, et al. Incidence and types of adverse events and negligent care in Utah
and Colorado. Med Care 2000;38(3):261-71
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Adverse Drug Events
Adverse Drug Events
Common in elderly
Important cause of morbidity and death
Type “A”
Dose related
Predictable
Potentially avoidable
Beers Criteria/List
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Beers Criteria/List
What it’s not….
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Beers Criteria/List
Originally conceived in 1991 by Mark Beers,
MD (geriatrician)
1991 1997 2003 2012 2015
Identifies medications that
pose potential risks
outweighing potential
benefits for people ≥65 years
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Beers List Intended Use
Goal: To improve care of older adults by
decreasing exposure to potentially
inappropriate medications (PIM)
Risks outweigh the benefits
Not meant to be punitive
Does not supersede clinical judgment
Individual patient’s values & needs
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Evidence Base
LESS IS MORE
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Shabot “Let’s not Boil the
Ocean” Beers List Proposal
Design CDS interventions to help
prevent falls, fractures and deaths in
elderly
Create a review panel
Clinicians
Pharmacists
Informaticists
Identification of target medications
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Governance
Clinical Decision Support Oversight
Beers Criteria Workgroup
Physicians
Pharmacists
Medical Informatics
Acute Care Medical Informatics Committee
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Key Decisions
Target Medications
Phased Approach
Alternative Medications
CDS Interventions
Alerts
Order Sets
Order Sentences
Measuring Processes
Measuring Outcomes
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IT Interventions
Alerts
Notification alerts for using caution
Alternative medications included
Pharmacist consults
Update Order Set Content
Add comments on PIM for elderly
Create “smart” orders
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Beers Criteria Alert
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Pharmacist Consult
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Order Set
Smart Orders
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Order Set
Smart Orders
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Alert Data
Daily/ Monthly Trends
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Alert Data
Override Rate/ Alert Volume
Facility 1
Facility 2
Facility 3
Facility 4
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Outcome Measures
Good Catches
Alerts backed out and therapy changed
Volume of orders for elderly patients
Are we seeing more elderly patients (>65 yrs)?
# of Orders per 1000 elderly patients (>65 yrs)
Serious Safety Events
Elderly patient falls
Related to Beers list medications
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Good Catches
Facility 1
Facility 2
Facility 3
Facility 4
Total of 39,172 Good Catches since
alert implementation
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Orders Data: 7 Drugs
Account for 80% of all orders
~28% Reduction
Alert Go-Live (4/15/14)
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Prevention
Assumption
Estimated
ADE’s
Estimated Cost
Savings
Estimated
Lives Saved
Estimated
SSEs
Prevented
ADE’s prevented per
potential medication
error prevented
Good
Catches
N=39,172
$ 2,595 per
adverse drug
event
1% 12%
1 in 2 19,586 $ 50,825,670 196 2,350
1 in 4 9,793 $ 25,412,835 98 1,176
1 in 8 4,897 $ 12,707,715 49 588
1 in 16 2,448 $ 6,352,560 24 288
1 in 32 1224 $ 3,176,280 12 144
Financial Impact
PIM in Elderly Patients
Estimates based on Bates DW, et al. JAMA 1997;277(4): 307-311 and JAMA 1995:274(1): 29-34
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Closing Thoughts
• “To”
Governance
Measure, measure and measure
Talk about the success
vs. “With”
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anwar.sirajuddin@memorialhermann.org
Questions